CH A PT ER 4
CMS
CMS. LEVEL 2: EMERGING EVIDENCE-BASED INTERVENTIONS FOR CHILDREN
TABLE 4.5INTERVENTION
(Number of Studies Reviewed) BRIEF DESCRIPTION EXAMPLES
Language Training (Production) (4) Massage/Touch Therapy (2) Modeling (9)
These interventions have as their primary goal to increase speech production
These interventions involve the provision of deep tissue stimulation
These interventions rely on an adult or peer providing a demonstration of the target behavior that should result in an imitation of the target behavior by the individual with an ASD
The goal of this approach is to increase expressive language production. Treatment is composed of elements from discrete trial learning, natural environment teaching, and incidental teaching procedures. Teaching techniques incorporate direct instruction and can be effective in increasing and maintaining responsive and spontaneous speech production in a child with autism.
Studies suggest that massage therapy can be used to reduce stereotypic behavior and increase on-task responding and social relatedness. Less touch aversion, deeper sleep, and fewer autistic symptoms are also suggested as massage treatment outcomes. For children with autism, video modeling has been used to increase social initiation skills, shared play engagement, and imitation of socially appropriate behaviors. Other examples of video modeling include combining other strategies such as contingent reinforcement to teach conversational and self-care skills to children with autism. Use of video modeling to teach perspective taking has been less successful especially for generalized perspec- tive taking in novel environments.
(CONTINUED) (CONTINUED) Effective, Established, Evidence-based, or Level 1 Ineffective Emerging, Marginal, or Level 2 Unestablished, Insufficient Evidence, or Level 3 KEY
CMS. LEVEL 2: EMERGING EVIDENCE-BASED INTERVENTIONS FOR CHILDREN
TABLE 4.5INTERVENTION
(Number of Studies Reviewed) BRIEF DESCRIPTION EXAMPLES
Music Therapy
(4)
Pivotal Response Treatment (PRT)
(5)
These interventions seek to teach individual skills or goals through music
This treatment is also referred to as PRT, Pivotal Response Teaching, and Pivotal Response Training. PRT focuses on targeting “pivotal” behavioral areas – such as motivation to engage in social communica- tion, self-initiation, self- management, and responsive- ness to multiple cues, with development of these areas having the goal of very wide- spread and fluently integrated collateral improvements
Music therapists use music to teach children with autism to commu- nicate and express feelings. Use of music can be structured to address behavioral, social, physical, sensory- motor, and cognitive abilities. The most notable effects are on verbal and gestural communicative skills. The music therapist reinforces singing, listening, moving, playing instruments, and other activities in a prescribed manner to develop skills in the above areas. The most frequently used interventions are interactive instrument playing, musical instrument instruction, interactive singing, and choice of instrument and song.
For children with autism, the abilities that are most “pivotal” to all areas of development are communication, cognition, and social-emotional functioning. Improvement in these areas promotes acquisition and gener- alization of new skills that were not specifically targeted. PRT as a treatment provides maximum motivation for the child to respond by allowing the child to choose the activity, receive a clear instruction, and gain a reinforcer for a success- ful attempt. The reinforcer is the object of the child’s initial choice. PRT takes advantage of naturally occurring teaching opportunities and uses naturally occurring conse- quences to strengthen behavior.
(CONTINUED) (CONTINUED)
CH A PT ER 4
CMS
CMS. LEVEL 2: EMERGING EVIDENCE-BASED INTERVENTIONS FOR CHILDREN
TABLE 4.5INTERVENTION
(Number of Studies Reviewed) BRIEF DESCRIPTION EXAMPLES
Reductive Package (3) Scripting (3) Self-management (6)
These interventions rely on strategies designed to reduce problem behaviors in the absence of increasing alterna- tive appropriate behaviors
These interventions involve developing a verbal and/or written script about a specific skill or situation which serves as a model for the child with ASD. Scripts are usually prac- ticed repeatedly before the skill is used in the actual situation
These interventions involve independence by teaching in- dividuals with ASD to regulate their behavior by recording the occurrence/non-occurrence of the target behavior, and secur- ing reinforcement for doing so. Initial skills development may involve other strategies and may include the task of setting one’s own goals
When behaviors become dangerous, consideration is given to reductive treatment procedures, for example, when a child with autism
repeatedly ingests non-edible objects (pica behavior). It has been shown that foods that are aversive to the child can be delivered contingently to effectively reduce the pica behavior. Most reductive procedures use a combination of reinforcement and punishment procedures to reduce severe negative behavior. However, more positive approaches such as functional assessment, differential reinforcement of incompatible or alternative behavior, and antecedent interventions are being developed to offset use of aversive approaches.
Examples of teaching children with autism using scripts include target- ing elements of conversational speech, prompting engagement in conversational exchanges, and initiating socially to peers. Scripted prompts can be delivered by trained peers by using printed text that is slowly faded out, or by using embedded text for children able to read words.
Self-management combines techniques of self-assessment, self- recording, and self-reinforcement to reduce repetitive or disruptive behaviors (e.g., vocalizations, body movements) and improve on-task behavior. The student is taught to recognize the targeted behavior and record its occurrence. The student is then taught how to self- reinforce when a specified times elapses without the occurrence of the targeted behavior.
(CONTINUED) (CONTINUED) Effective, Established, Evidence-based, or Level 1 Ineffective Emerging, Marginal, or Level 2 Unestablished, Insufficient Evidence, or Level 3 KEY